Common use of Nursing Facility Services Clause in Contracts

Nursing Facility Services. ‌ The CHC-MCO is responsible for payment for Medically Necessary NF services, including bed hold days and up to fifteen (15) days per hospitalization and up to thirty (30) Therapeutic Leave Days per year if a Participant is admitted to an NF or resides in an NF at the time of Enrollment. The CHC-MCO must, in coordination with the Department, monitor for completion of all NF-related processes, including but not limited to: PASRR process, specialized service delivery, Participant’s rights, patient pay liability, personal care accounts, or other identified processes. In each CHC zone, and for at least 18 consecutive months following the Implementation Date, the CHC-MCO must contract, with any NF enrolled in the MA Program that: (1) is willing to accept, and does accept, the CHC- MCO’s payment rates; and (2) is willing to comply with, and does comply with, the quality and other standards and terms established by the Department and by the CHC-MCO. This requirement applies if the CHC-MCO contracts directly with individual NFs for services in its network or indirectly through provider groups or other joint arrangements. Before the expiration of the initial 18-month period, the Department, in its sole discretion and with notice to the CHC-MCO, may extend this requirement for an additional period determined by the Department and again for any additional periods thereafter. The Department may, in its sole discretion and upon notice to the CHC-MCO, impose any other NF network contracting requirements that the Department determines are necessary to ensure that Participants have adequate access to NF care.

Nursing Facility Services. ‌ The CHC-MCO is responsible for payment for Medically Necessary NF services, including bed hold days and up to fifteen (15) days per hospitalization and up to thirty (30) Therapeutic Leave Days per year if a Participant is admitted to an NF or resides in an NF at the time of Enrollment. The CHC-MCO must, in coordination with the Department, monitor for completion of all NF-related processes, including but not limited to: PASRR process, specialized service delivery, Participant’s rights, patient pay liability, personal care accounts, or other identified processes. In each CHC zone, and for at least 18 consecutive months following the Implementation Date, the CHC-MCO must contract, with any NF enrolled in the MA Program that: (1) is willing to accept, and does accept, the CHC- MCO’s payment rates; and (2) is willing to comply with, and does comply with, the quality and other standards and terms established by the Department and by the CHC-MCO. This requirement applies if the CHC-MCO contracts directly with individual NFs for services in its network or indirectly through provider groups or other joint arrangements. Before the expiration of the initial 18-month period, the Department, in its sole discretion and with notice to the CHC-MCO, may extend this requirement for an additional period determined by the Department and again for any additional periods thereafter. The Department may, in its sole discretion and upon notice to the CHC-MCO, impose any other NF network contracting requirements that the Department determines are necessary to ensure that Participants have adequate access to NF care.

Nursing Facility Services. ‌ The CHC-MCO is responsible for payment for Medically Necessary NF services, including bed hold days and up to fifteen (15) days per hospitalization if the NF satisfies the occupancy percentage requirements and up to thirty (30) Therapeutic Leave Days per year if a Participant is admitted to an a NF or resides in an a NF at the time of Enrollment. The CHC-MCO must, in coordination with the Department, monitor for completion of all NF-related processes, including but not limited to: PASRR process, specialized service delivery, Participant’s rights, patient pay liability, personal care accounts, or other identified processes. In each CHC zone, and for at least 18 consecutive months following the Implementation Date, the CHC-MCO must contract, with any NF enrolled in the MA Program that: (1) is willing to accept, and does accept, the CHC- MCO’s payment rates; and (2) is willing to comply with, and does comply with, the quality and other standards and terms established by the Department and by the CHC-MCO. This requirement applies if the CHC-MCO contracts directly with individual NFs for services in its network or indirectly through provider groups or other joint arrangements. Before the expiration of the initial 18-month period, the Department, in its sole discretion and with notice to the CHC-MCO, may extend this requirement for an additional period determined by the Department and again for any additional periods thereafter. The Department may, in its sole discretion and upon notice to the CHC-MCO, impose any other NF network contracting requirements that the Department determines are necessary to ensure that Participants have adequate access to NF care.